This study examined toothbrushing and its associated factors in children aged 1–4 years, using data from 306 mother-father-dyads and their 308 children participating in the FinnBrain Birth Cohort Study. Longitudinal multivariable regression analysis was conducted using the generalized estimating equation method to model the outcome, parent-reported brushing of a child’s teeth less than twice daily at the child’s age of 12, 24 and 48 months, controlling for the intraindividual correlation between repeated measurements using compound symmetry (correlation structure). The independent variables as time-varying covariates from 12 to 48 months were mother’s and father’s own toothbrushing, couple relationship satisfaction, number of positive life events of father, and fixed covariates were number of siblings, education level of mother and age of parents. Among the children, 50% had stable good and 16% stable poor toothbrushing habits from 1 to 4 years. Both parents’ less than twice daily brushing was strongly associated with less than twice daily brushing of a child’s teeth. The strength of the association between brushing mother’s own and the child’s teeth varied across time, whereas this association in fathers remained consistent. Early family-based intervention is crucial for promoting parents’ own brushing habits and thereby supporting children’s oral hygiene.

Objectives: This longitudinal study examined the association of parents' dental anxiety during early pregnancy with the stability of brushing their own and their children's teeth from the age of one to four years. Methods: The study used data from the FinnBrain Birth Cohort Study, which included 816 mothers and 379 fathers who completed questionnaires on dental anxiety at gestational week 14 and on toothbrushing frequency for themselves and their child at the ages of 1, 2, and 4 years. Dental anxiety was assessed using the Modified Dental Anxiety Scale. The stability of toothbrushing was categorized as stable good (twice daily or more at all time points), fluctuating, good at 4 years (fluctuates over time points, but good at age 4 years), fluctuating, poor (less than twice daily) at 4 years (fluctuates over time points, but poor at age 4 years), stable poor (poor at all time points). Unordered multinomial logit models regarding the association of parents' dental anxiety on brushing their own and their children's teeth were adjusted for education, and education and parents' own toothbrushing, respectively. Results: Compared to the mothers who brushed their teeth twice daily throughout the study ("stable good"), those belonging to the "fluctuating, good at 4 years" group and those belonging to the "stable poor/poor at 4 years" group were more likely to have higher dental anxiety (OR = 1.07, 95% CI = 1.01-1.13 and OR = 1.04, 95% CI = 1.00-1.08, respectively). This association was not found among fathers. Parents' dental anxiety was not associated with the brushing of their children's teeth. Conclusions: Attending to the mother's dental anxiety during pregnancy could improve her toothbrushing.

Objective: To analyze the effects of cervical headgear (CHG) timing on costs and orthodontic outcome. Material and methods: Sixty-seven participants with Class II malocclusion were randomized into two groups. In the early group (EG, n = 33), CHG treatment began after the eruption of first upper molars. In the later-timed group (LG, n = 34), CHG treatment began nearly 2 years later. Orthodontic outcome was evaluated when CHG ended and at the end of follow-up using the Peer Assessment Rating (PAR) index and Little’s Irregularity Index (LII). Costs were calculated using medical records, estimated chairside times and average personnel and material costs. Results: The mean total costs including personnel and material costs during the follow-up were higher in the EG (€416) compared with the LG (€364) (p = 0.043). No statistically significant differences between the groups were found in the PAR and in the LII scores at the end of follow-up. The number of visits during CHG treatment was higher in the EG (13.3) compared with the LG (10.4) (p = 0.01). Conclusions: Earlier initiation of CHG treatment increased the personnel and material costs, number of appointments, and chairside time. Based on the PAR and in the LII scores, the orthodontic outcome of CHG treatment was equal regardless of the timing of the treatment. If orthodontic treatment during mixed-dentition stage is considered, it would be justified from an economic perspective to favor treatment during late mixed-dentition.

BACKGROUND:Body pain widespreadness may be related to biopsychosocial impact in TMD (temporomandibular disorders) pain patients. OBJECTIVES:The aim was to assess, by using pain drawings (PDs), the whole-body pain locations/widespreadness and their association with pain-related intensity/interference and clinical Axis I diagnoses among Finnish tertiary care TMD pain patients using the DC/TMD-FIN (Diagnostic Criteria for TMD-FIN). METHODS:Based on PDs, 197 TMD pain patients were divided into PD profile subgroups: PD-1 (local head/face pain), PD-2 (regional head and neck/shoulder pain) and PD-3 (widespread pain). Using the Graded Chronic Pain Scale 2.0 (GCPS 2.0) assessing pain-related intensity/interference, the patients were classified into TMD subtypes (1 = uncompromised, 2 = moderately, 3 = severely compromised). Based on quantitative analysis of PDs, PD score was calculated, considering the pain widespreadness. Differences between PD profile subgroups in TMD subtypes, PD scores and Axis I diagnoses were evaluated with Independent Samples Kruskal-Wallis and chi-squared tests and pairwise comparisons with Mann-Whitney U test with Bonferroni correction. PD score sum was explored by linear regression with age, sex, Axis I diagnoses and TMD subtype as independent variables. RESULTS:Patients were evenly distributed by PD profiles. Patients with widespread PD-3 profiles were significantly more often classified into TMD subtype 3, had higher PD scores and more pain-related Axis I diagnoses as compared to local PD-1 and regional PD-2. CONCLUSION:Among TMD pain patients widespread pain associates with biopsychosocial impact. PD is an important adjunct tool in biopsychosocial Axis II assessment of TMD pain patients for treatment planning and personalised care.

We aimed to identify factors predicting toothbrushing less than twice daily at the age of 2 years. The data from the FinnBrain Birth Cohort Study of 506 mother-father pairs (with 506 children) were used. Logistic regression analyses were conducted of the outcome (brushing less than twice daily) at the age of 24 months. Independent variables were parental age, parental education, siblings in the household, use of childcare service, and information about whether the parents are divorced, as well as brushing of the child's teeth and the parents' own teeth at 12 months with their first order interactions. More than one quarter of the parents reported brushing their child's teeth less than twice daily at the age of 2 years. The strongest predictor for brushing the child's teeth less than twice daily at the age of 24 months was brushing child's teeth less than twice daily at the age of 12 months; the effect was significantly stronger for those children whose fathers had low education than for those whose fathers had medium/high education. Other predictors were mother's and father's own brushing at 12 months, childcare at home, and mother's low education. To improve toothbrushing in young children, early intervention is needed in families where parents brush their own teeth less than twice daily and in families with low education.

OBJECTIVES:The aim was to evaluate the association between public oral healthcare procedures and change in oral health-related quality of life (OHRQoL) over 4 years among parents in the FinnBrain Cohort Study, comparing those who did not visit public oral healthcare. METHODS:The study used data on parents of young children from the FinnBrain Birth Cohort Study (www.finnbrain.fi) and healthcare centers' national patient data register. OHRQoL was measured with the 14-item Oral Health Impact Profile (OHIP-14). Of those who had answered the OHIP-14 questionnaire at gestational week (gw) 34 and 4-year time points (n = 1552), 589 had visited a public oral healthcare service. OHIP-14 severity score, two thresholds of prevalence and their changes were evaluated according to gender and public oral healthcare visits (Mann-Whitney U test, ꭓ2 test, and Wilcoxon signed ranks test). Correlations between treatment procedures and OHRQoL were evaluated among those who had visited public oral healthcare service. The association between OHRQoL and its change with different treatment procedures was evaluated by using Spearman correlation coefficients. RESULTS:OHRQoL did not change for the majority of parents, regardless of visiting public oral healthcare services, or if they received oral healthcare treatment or only preventive procedures. Change in OHRQoL and treatment procedures showed a weak association. OHRQoL worsened most for those receiving treatment in four or more procedure groups. Changes in OHRQoL were not clinically meaningful. CONCLUSIONS:Oral healthcare procedures seem to have a limited impact on OHRQoL changes among parents of young children.

We have developed a novel Bayesian Linear Structural Equations Model (BLSEM) with variable selection priors (available as an R package) to build directed acyclic graphs to delineate complex variable associations and pathways to BMI development. Conditional on standard assumptions used in causal inference, the model provides interpretable estimates with uncertainty for natural direct, indirect (mediated) and total effects. We showcase our method using data on 4119 offspring followed from the pre-pregnancy period to age 46 years (y) in a Finnish population-based birth cohort. The BLSEM enabled efficiently to analyse all available data over the long-time span, identifying factors to distil potential causal pathways contributing to adult BMI development. All of the associations between early childhood and adolescence variables with adult BMI at 46 y (BMI46) were indirect via multiple paths. For example, maternal prepregnancy BMI, smoking and socioeconomic position are associated with BMI46 through 35, 31 and 26 paths. Another notable feature was that the contribution of very early life factors, particularly prenatal, was captured by growth patterns along childhood, which were the strongest early predictors of middle age BMI46 (the age at adiposity rebound (AgeAR), early growth parameters between the AgeAR to 11 y). BMI and blood pressure measured 15 y earlier also predicted BMI46, all other factors held constant. Genetic predisposition by the polygenic risk score for BMI showed an indirect effect that became apparent at AgeAR and thereafter. The Bayesian approach we present and the BLSEM software developed advances methodologies for the analysis of complex, multifaceted life-course data prior to the estimation of potential causal pathways. Our results, although exploratory in nature, suggest that the effective interventions to tackle adverse BMI development could be designed throughout childhood, though the period by AgeAR may be paramount. We feature the importance of integrated life-course analyses that help to understand the contribution of life-stage factors of development.

BACKGROUND:To evaluate the association of oral parafunctions with clinical DC/TMD (Diagnostic Criteria for Temporomandibular Disorders) Axis I diagnoses, Axis II biopsychosocial assessment and pain widespreadness in TMD pain patients in tertiary care. METHODS:197 TMD pain patients were clinically examined and responded to DC/TMD OBC (Oral Behaviour Checklist) and Axis II comprehensive instruments. Patients were divided into Pain Drawing (PD) profile subgroups: PD-1 = head/face pain; PD-2 = head and neck/shoulder regional pain; PD-3 = widespread pain. Using the Graded Chronic Pain Scale 2.0 assessing pain-related intensity/interference, the patients were classified into TMD subtypes 1-3. Associations of frequent sleep bruxism (4-7 times per week) and daytime clenching (most/all of the time) with explanatory variables were evaluated with Independent Samples Kruskal-Wallis and chi-square tests and pairwise comparisons were made with Mann-Whitney U-test with Bonferroni correction. RESULTS:Frequent sleep bruxism was reported by 46.2% and daytime clenching by 67.5% of the participants. Sleep bruxism and daytime clenching associated significantly with muscle-related TMD diagnoses. Sleep bruxism and daytime clenching were significantly associated with anxiety (GAD-7, General Anxiety Disorder-7) subgroups, the highest prevalence being in the most severe subgroups. Frequent sleep bruxism was reported more by participants in TMD subtype 2 as well as those in PD-2 and PD-3 profile subgroups, with significant differences between PD-1 vs. PD-2 and between PD-1 vs. PD-3. CONCLUSIONS:Oral parafunctions are associated with muscle-related TMD diagnoses, anxiety symptoms and wider body pain, which should be considered in the assessment, treatment planning and personalized care of TMD pain patients.

AIM:The study aimed to compare long- and short-term frequent attenders' (FAs) perceptions of patient-centredness and to assess the equivalence of the factor structure of patient-centred primary care (PCPC) instrument for long- and short-term FAs. METHODS:A cross-sectional survey of long-term (n = 234) and short-term (n = 261) FAs within the primary healthcare of one city in Finland. The data collected in January-July 2020 via 'the 36-item PCPC instrument' were analysed using Pearson's chi-squared test, Mann-Whitney U-test, Cronbach's alpha, and multigroup confirmatory factor analysis (MGCFA). RESULTS:Long-term FAs had worse perceptions of patient-centredness than short-term FAs across all subscales: patients' preferences, physical comfort, coordination of care, continuity and transition, emotional support, access to care, information and education, and family and friends. The MGCFA indicated a good fit for the predicted eight-factor model. CONCLUSIONS:Long-term FAs' care needs are currently not being met, indicating the need for considering how the way healthcare services are arranged and care is provided affects prolonged and high care needs. Various dimensions of patient-centredness need to be addressed when developing not only FAs' care but also wider service paths. A distinction should be made between long- and short-term frequent attendance when identifying and addressing FAs' service needs.

Background/rationale: Systematic reviews on the effects of pacifiers on occlusion have highlighted the need for quality RCTs. Trial design: Single region, three parallel-armed, prospective, randomized controlled trial. Objectives: To investigate the correlations between early childhood non-nutritive sucking habits and malocclusion. Specifically to test whether the use of a study pacifier has differing effects compared to other pacifiers and control, and whether the duration of pacifier use or digit sucking influence the occlusion. Participants: The subjects were firstborn children, born in 2008 in Vantaa, Finland. Intervention: One-third of participants were offered study pacifiers, free of charge, from birth up to 2 years of age. The history of the subjects' sucking habits, including pacifier use was screened in a questionnaire at the age of 2 years, and clinical examinations were performed at the age of 7 years. In addition, the subjects were divided into groups that were equally matched regarding their mother's level of education. Outcomes: Posterior crossbite, anterior crossbite, overjet, deep bite, open bite, and crowding. Randomization method: Three districts were randomly allocated to three study groups by drawing lots. Blinding: It was not possible to blind the clinicians or parents from the intervention. Blinding during data analysis was performed. Results: From the original cohort of 2715 children born in the town of Vantaa, 1911 were excluded and 353 were lost to follow-up. The remaining 451 children were divided into three groups according to the use of pacifiers. The prevalence of posterior crossbite at the age of 7 years was higher if a non-study pacifier had been used (P = .005) even when matched for the mother's level of education (P = .029). The prevalence of posterior crossbite was higher if the pacifier habit had continued for 12 months or more compared to 11 months or less, 7% and 1%, respectively, (P = .003). Digit sucking for 12 months or more was associated with crowding (P = .016). The prevalence of crossbite in the study pacifier group was less than in control pacifiers. Harms: No adverse harms were reported other than effects on the dentition. Conclusion: The use of pacifiers is associated with the posterior crossbite, especially if their use continues for a year or more. Parents/guardians should be advised to stop the use or reduce the use of pacifiers to a minimum after their child's first birthday.

OBJECTIVE:This study aimed to evaluate the association between temporomandibular disorders (TMD) and oral health-related quality of life (OHRQoL) in an adult population. METHODS:The data included 1,768 adults 46 years of age in the Northern Finland Birth Cohort 1966 (NFBC1966) study. The symptoms, signs and diagnoses of TMD were assessed using a modified protocol of the Diagnostic Criteria for TMD (DC/TMD) and validated questionnaires. OHRQoL was measured using the Oral Health Impact Profile (OHIP-14). Associations of TMD and OHRQoL were evaluated with χ2 -test and Fisher's exact test. RESULTS:In females, pain-related TMD signs and diagnoses associated significantly with prevalence of OHIP total and all dimensions, whereas in joint-related TMD, psychological dimensions showed the strongest association. Males with pain- or joint-related TMD, the most impaired dimension was physical pain. CONCLUSION:Pain-related TMD seems to associate more strongly with lower OHRQoL than joint-related TMD especially in females.

We evaluated associations between changes in dental anxiety and tobacco use, adjusted for general anxiety and depressive symptoms. The FinnBrain Birth Cohort Study data, collected at gestational weeks 14 and 34 and at 3 months postpartum, were used. Questionnaires included the Modified Dental Anxiety Scale (MDAS), the Edinburgh Postnatal Depression Scale (EPDS), and the anxiety subscale of the Symptom Checklist-90 (SCL). Smoking was categorized as "stable non-smoking", "started smoking", "quit smoking", and "stable smoking". Changes in smoking and dental anxiety were evaluated "during pregnancy" (i.e., from gestational week 14 to gestational week 34) in 2442 women and 1346 men and "after pregnancy" (i.e., from gestational week 34 to 3 months postpartum) in 2008 women and 1095 men. Changes were evaluated in three smoking categories (stable non-smoking, fluctuating, and stable smoking), using data from all three time-points (1979 women and 1049 men). Modeling used repeated measures analysis of covariance. Stable smoking mothers had statistically significantly higher levels of dental anxiety (mean MDAS 12.3-12.6) than non-smoking mothers (mean MDAS 10.1-10.7) or mothers who smoked at some point during pregnancy (mean MDAS 10.8-11.5). A similar tendency was observed in fathers. However, no systematic change in dental anxiety by changes in smoking habits was observed. Those smoking during pregnancy and with high dental anxiety may need special support for smoking cessation.

Summary Aim The aim of this study was to investigate the gender-specific associations between dental aesthetics, oral health-related quality of life (OHRQoL), and satisfaction with dental aesthetics in an adult population. Materials and methods The study population consisted of 1780 individuals (822 males and 958 females) from the Northern Finland Birth Cohort 1966 (NFBC1966). Dental aesthetics were evaluated from digital 3D dental models using the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). Layperson and orthodontist panels evaluated the dental aesthetics of a smaller sample (n = 100). OHRQoL was measured using the Oral Health Impact Profile (OHIP-14) questionnaire. Satisfaction with dental aesthetics was asked with one separate question. Gender-specific analyses consisted of Mann–Whitney U-tests and Spearman’s correlation coefficients. Results More than half of the population had an aesthetically acceptable occlusion, and most of the individuals were satisfied with the aesthetics. The most severe aesthetic impairments were associated with the psychological dimensions of OHIP-14. There were significant but weak associations of AC and satisfaction with aesthetics, and satisfaction with aesthetics and OHRQoL. Significant gender differences were found, men having higher mean AC scores but women reporting lower OHRQoL. Conclusion At the population level, most of the individuals were satisfied with their aesthetics, despite different dental aesthetic conditions. The most severe aesthetic impairments were associated with decreased psychological well-being, women reporting more impacts compared to men.

BACKGROUND:Dental arch effects after cervical headgear (CHG) treatment have been researched from several different perspectives. However, the long-term effects of CHG timing are still unknown.OBJECTIVES:To analyse the long-term effects of CHG timing on dental arches.MATERIAL AND METHODS:A total of 67 children with Angle Class II malocclusion comprised the study group in this trial. The participants were randomized into two equal-sized groups. In the early group (EG, n = 33), treatment was started after the eruption of the first upper molars. In the later-timed group (LG, n = 34), treatment was started 18 months later compared with the early group. Long-term effects were measured from dental casts taken at five time points between 7 and 18 years of age.RESULTS:The total maxillary dental arch length was achieved earlier, the gained length persisted better in the long term, and significantly more space was achieved in EG compared with LG (P = .048). The intermolar width in the maxillary dental arch was more stable and was reached earlier in EG compared with LG (P = .002). The results showed that in terms of total mandibular arch length increases, EG males benefited the most and LG females the least from CHG treatment (P = .031).CONCLUSIONS:Both genders benefited from earlier CHG treatment. The maxillary dental arches remained longer, and the final width was gained earlier in EG compared with LG.

OBJECTIVES:The aims were (1) to study the association between dental anxiety (DA) and temporomandibular disorders (TMDs) and whether subgroups formed differ in psychological symptoms and pain sensitivity in the Northern Finland Birth Cohort 1966 and (2) to confirm the factor structure of the Hopkins Symptom Checklist-25 assessing psychological symptoms. MATERIALS AND METHODS:Data were acquired using questionnaires and clinical examinations at age 46 years (n = 1889). Dental anxiety was assessed with Modified Dental Anxiety Scale (MDAS). Pain-related TMD (myalgia, arthralgia) were assessed according to modified diagnostic criteria for temporomandibular disorders. Pressure pain threshold and tolerance were measured with an algometer. Explanatory factor analysis revealed three factors, named 'depression', 'anxiety' and 'distress'. RESULTS:Those with high DA and myalgia and/or arthralgia reported higher depression (mean = 1.52), anxiety (mean = 1.61) and distress (mean = 2.06) scores, and lower pressure pain threshold (mean = 496 kPa) and tolerance (mean = 741 kPa) values than those with only DA (1.22; 1.56; 1.84; 613; 875), TMD (1.21; 1.39; 1.83; 600; 908) or neither (1.12; 1.29; 1.58; 707; 1006), respectively. CONCLUSIONS:Patients with DA and/or myalgia/arthralgia have similar profiles regarding pain sensitivity and psychological symptoms, the burden being highest among those with DA and a TMD diagnosis.

Abstract Objective To examine the prevalence of sagittal relationships, asymmetries and midline shift, and their associations with temporomandibular disorders (TMD) in the Northern Finland Birth Cohort 1966 (NFBC1966). Materials and methods 1845 subjects participated in a clinical examination at the age of 46. Occlusal measurements were performed using 3D models. Symptoms of TMD were screened using validated questions, and signs and diagnoses of TMD were assessed using a modified protocol of the Diagnostic Criteria for TMD (DC/TMD) and questionnaires. Associations between variables of occlusion and TMD were evaluated with χ 2-test and Fisher's exact test and using logistic regression analyses, adjusted for self-reported general health, mental health, bruxism, and rheumatoid arthritis. Results The most common sagittal relationships were Class I and normal canine relationship. Half-cusp Class II and post-normal canine relationship were more frequent in females, and Class III and pre-normal canine relationship in males. Deviations from normal cuspid or molar relationships showed a weak but statistically significant association with TMD, especially in females. Half-cusp Class II and Class II relationships were more frequent in relation to joint-related TMD signs and diagnoses while missing canines were associated with pain-related TMD diagnoses. Conclusions The present study findings gave some indications that canine relationships are associated with pain-related TMD, whereas Angle II sagittal occlusal relations may associate with joint-related TMD. Occlusal characteristics should therefore be taken into account as one possible associating factor in subjects with TMD.

OBJECTIVE The aim of the study was to examine the tooth brushing frequency and use of fluoridated toothpaste of the mother and father were associated with the tooth brushing frequency and use of fluoridated toothpaste for their 1-year-old child. METHODS This cross-sectional study is part of the FinnBrain Birth Cohort Study. Questionnaire data were obtained from 1672 mothers and 867 fathers on tooth brushing and use of fluoridated toothpaste, age, education, number of siblings and parity (when the child was 1-year-old). For 763 families (mother and father), data from both parents were available. Tooth brushing was dichotomized to at least twice daily (2× day) and less than 2× day, and use of fluoridated toothpaste for child to at least once daily and less than once daily. The association between brushing of child's teeth (both parents less than 2× day) and use of fluoridated toothpaste for the child (both parents less than once daily) with parent's own tooth brushing was modelled with logistic regression analyses adjusted for family-related variables (parents' age and education, number of older siblings) using odds ratios (OR) and 95% confidence intervals (CI). RESULTS Families in which both parents brushed their own teeth less than 2× day were more likely to brush their child's teeth less than 2× day than families in which both parents brushed their own teeth 2× day (OR = 9.23; 95%CI = 5.42-15.69). The likelihood of not brushing the child's teeth 2× day was less strong when at least one of the parents brushed his/her own teeth 2× day (mother 2× day: OR = 1.97; 95%CI = 1.25-3.10; father 2× day: OR = 2.85; 95%CI = 1.51-5.40). CONCLUSIONS Less frequent tooth brushing of both mothers and fathers was strongly associated with less frequent tooth brushing of their child. When educating parents on child oral home care, parents' own home care and inclusion of fathers also need more attention.

Objectives Type 2 diabetes (T2D) and comorbid depression challenges clinical management particularly in individuals with overweight. We aim to explore the shared etiology, via lifecourse adiposity, between T2D and depression. Methods We used data from birth until 46years from Northern Finland Birth Cohort 1966 ( n = 6,372; 53.8% females). We conducted multivariate analyses on three outcomes: T2D (4.2%), depression (19.2%) and as comorbidity (1.8%). We conducted (i) Path analysis to clarify time-dependent body mass index (BMI) related pathways, including BMI polygenic risk scores (PRS); and (ii) Cox regression models to assess whether reduction of overweight between 7years and 31years influence T2D, depression and/or comorbidity. The models were tested for covariation with sex, education, smoking, physical activity, and diet score. Results The odd ratios (OR) of T2D in individuals with depression was 1.68 [95% confidence interval (CI): 1.34–2.11], and no change in estimate was observed when adjusted for covariates. T2D and comorbidity showed similar patterns of relationships in the path analyses ( P < 0.001). The genetic risk for obesity (PRS BMI) did not show direct effect on T2D or comorbidity in adulthood but indirectly through measures of adiposity in early childhood and mid-adulthood in the path analysis ( P < 0.001). Having early-onset of overweight at 7years and 31years showed highest risk of T2D (OR 3.8, 95%CI 2.4–6.1) and comorbidity (OR 5.0, 95%CI 2.7–9.5), with mild-to-moderate attenuation with adjustments. Depression showed no significant associations. Conclusions We found evidence for overweight since childhood as a risk factor for T2D and co-morbidity between T2D and depression, influenced moderately by lifestyle factors in later life. However, no shared early life adiposity related risk factors were observed between T2D and depression when assessed independently in this Finnish setting.

Summary Aim The aim of this study was to investigate malocclusion severity and its associations with oral health-related quality of life (OHRQoL) among middle-aged adults. Materials and methods The study material consisted of 1786 subjects from the Northern Finland Birth Cohort 1966 who attended dental and oral examination as part of the 46-year-old follow-up study. Malocclusion severity was assessed using the Dental Health Component (DHC) of the Index of Orthodontic Treatment Need (IOTN) and the Peer Assessment Rating index (PAR) from digital 3D dental models. Participants also answered a questionnaire including the Oral Health Impact Profile (OHIP-14) and a question on their satisfaction with occlusal function. Differences between malocclusion severity groups were evaluated for both genders separately. For adjusted models, multivariate Poisson regression models were conducted. Results In this study population, 31.3% had great or very great orthodontic treatment need according to DHC and the mean PAR total score was 22.05. The most severe malocclusions were associated with OHRQoL, especially the psychosocial and handicap dimensions, and satisfaction with occlusal function. There was a significant difference between genders, men having more severe malocclusion but women reporting more OHRQoL impacts. Conclusion One third of the study population were considered to have severe malocclusion. There was an association between malocclusion severity and OHRQoL in adult population, particularly in women.

Runsas palvelutarve aiheuttaa haasteita sekä asiakkaille itselleen että terveyspalvelujärjestelmälle asiakkaiden pyrkiessä saamaan tarpeitaan vastaavaa hoitoa. Vuorovaikutus on tärkeää asiakkaan ja terveydenhuollon ammattihenkilöiden kohtaamisissa. Tutkimuksen tarkoituksena oli vertailla lyhyt- ja pitkäaikaisesti paljon terveyspalveluja tarvitsevien asiakkaiden näkemyksiä vuorovaikutuksesta terveydenhuollon ammattihenkilöiden kanssa. Lisäksi tarkoituksena oli testata samalla kohderyhmällä Patient-Professional Interaction Questionnaire PPIQ-mittarin faktorirakenteen yhdenmukaisuutta. Aineisto kerättiin erään kaupungin hyvinvointipalveluiden pitkäaikaisesti (n=234) ja lyhytaikaisesti (n=261) paljon terveyspalveluja tarvitsevilta asiakkailta tammi-heinäkuussa 2020. Mittari sisälsi 16 vuorovaikutusta arvioivaa väittämää, jotka muodostavat neljä ulottuvuutta: tehokas kommunikaatio; kiinnostus asiakkaan näkemyksiä kohtaan; empatia; asiakkaan osallistaminen hoitoon. Kukin ulottuvuus sisälsi neljä väittämää. Aineisto analysoitiin Pearsonin khiin neliö -testillä, keski- ja hajontaluvuilla sekä Mann-Whitney U -testillä. Mittarin sisäistä johdonmukaisuutta arvioitiin Cronbachin alpha -reliabiliteettikertoimella ja mittausinvarianssia useamman ryhmän konfirmatorisella faktorianalyysillä. Pitkäaikaisesti paljon terveyspalveluja tarvitsevat asiakkaat arvioivat vuorovaikutuksen ammattihenkilöiden kanssa keskimäärin heikommaksi kuin lyhytaikaisesti paljon terveyspalveluja tarvitsevat asiakkaat. Asiakkaan hoitoon osallistaminen oli keskeinen vuorovaikutukseen liittyvä tekijä pitkäaikaisesti paljon terveyspalveluja tarvitsevien asiakkaiden arvioimana. Useamman ryhmän konfirmatorisen faktorianalyysin perusteella PPIQ-mittarin rakenne ja lataukset olivat samanlaiset lyhyt- ja pitkäaikaisesti paljon terveyspalveluja tarvitsevien asiakkaiden ryhmissä, mutta vastaukset eri väittämiin vaihtelivat ryhmien välillä. Paljon terveyspalveluja tarvitsevan asiakkaan ja terveydenhuollon ammattihenkilöiden välinen toimiva vuorovaikutus on tärkeä osa asiakaslähtöisiä terveyspalveluja.